Wikimedia Australia/Proxy form

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APPENDIX 3
FORM OF APPOINTMENT OF PROXY

I,                                                                                      

(name & username)

of                                                                                      

(address)

being a member of Wikimedia Australia Inc.

appoint                                                                                      

(name & username of proxy holder)

of                                                                                      

(address of proxy holder)

being a member of Wikimedia Australia Inc., as my proxy to vote for me on my behalf at the annual/special[1] general meeting of the Association to be held on

                                                                                     

(date of meeting)

and at any adjournment of that meeting.

My proxy is authorised to vote in favour of/against the following resolution (insert details of resolution).


                                                                                     

Signature of Proposer Date     /     /          
  1. Delete if not applicable